8613 Background: Little guidance is available regarding the optimum placement and use of implantable venous access devices (VAD) in cancer treatment. We present herein 10 years of experience with VAD in a university hospital oncology clinic. Methods: Post hoc analysis of prospectively collected records of 346 cancer patients in whom 362 VAD (Port-a-Caths) were placed between January 1995 to December 2005. Primary end points included need for instillation of tissue plasminogen activator (TPA) to restore patency, need for an x-ray dye study to determine catheter salvageability, and premature removal because of VAD failure. We used Chi-square analysis to compare VAD placement by the Radiology service under fluoroscopy vs. placement by Surgery in the operating room (OR), placement in the right vs. left chest and internal jugular (IJ) vs. subclavian (SC) vein placement. Results: OR-placed VAD, more often than Radiology-placed VAD required TPA for patency (18.6% vs 8.07%, p<0.01), a dye study (11.7% vs 2.69%, p=0.001) or premature removal (14.7% vs 5.38%, p<0.01). Right- and left-sided VAD were equally likely to receive TPA (9.2% vs 16.1%, p=0.11) but left-sided VAD required more dye studies (3.3% vs 10.7%, p=0.013) and were prematurely removed more often (5.5% vs 15%, p=0.007). 29 (8%) of VAD were prematurely removed because of infection (n=11), thrombosis(n=6), pain (n=2), mechanical malfunction (n=6) and others (n=4). Gender, age (< vs. > 60 years), site of placement (IJ vs. SC) or body mass index (< vs. > 25) had no bearing on the primary endpoints. Intrathoracic cancer was associated with more TPA treatment of the VAD (16.8% vs. 8.4%, p<0.023) but not with dye studies (7.9% vs. 4%, p=0.191) or removal (6.1% vs. 8.8%, p=0.517). Conclusions: AVAD will usually last until completion of cancer therapy. Occlusion or premature removal is less likely in a VAD placed on the right side under fluoroscopic guidance by an experienced radiologist. Thoracic disease, site of placement, obesity, age or gender do not determine adverse outcomes for VAD. No significant financial relationships to disclose.